Provider Demographics
NPI:1992746192
Name:MERCER, JONATHAN F (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:F
Last Name:MERCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SUNNYVIEW LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3135
Mailing Address - Country:US
Mailing Address - Phone:406-756-1433
Mailing Address - Fax:406-756-1446
Practice Address - Street 1:210 SUNNYVIEW LN
Practice Address - Street 2:SUITE 106
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3135
Practice Address - Country:US
Practice Address - Phone:406-756-1433
Practice Address - Fax:406-756-1446
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10917208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT117538Medicaid
MT96746OtherBLUE CROSS OF MT
I01191Medicare UPIN
MT011000409Medicare PIN